"Simply Me" Transgender Mental Health

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A Global Look at Transgender Mental Health

@simply__me

TABLE OF CONTENTS

Intro….1

Thailand…2

Hawaii..…4

Uganda……5

El Salvador….7

Sweden…9

Kate Lewis

Justin Siu

Cherisse Sen

Valeria Rivera

Angie Mar

Sam Segal

Transgender.

By Kate Lewis

Is it a disease, as it is still classified by the World Health Organization? Is it a choice? A way in which someone is born? According to WHO, transgender is a term for people whose gender identity and expression do not conform to the norms as well as to those assigned to them at birth. Transgenderism includes people who are transsexual, people who are transgender, and anyone else whose gender is considered nonconforming. Only in 2013, when DSMIV was released, did the American Psychiatric Association update its criteria for gender identity disorder to differentiate it from sexual disorders and paraphilic disorders. In large part, in the medical community, transgenderism is lumped together with gay, lesbian, and bisexual, and considered a concern mostly in regard to the global spread of HIV. In fact, the only contact information listed for transgenderism at WHO is the HIV/AIDS department.

(adj.) denoting or relating to a person whose self-identity does not conform unambiguously to conventional notions of male or female gender.

But globally, there are more issues linked to transgenderism than just HIV. Across different cultures, there are a variety of terms someone who is transgender might use to identify themselves. In India, transgender people use the word “hijra,” and in Thailand, they refer to themselves as “kathoey.” And across these cultures, there are also different struggles that come with being a “nonconformist” transgender person. In September 2015, the UN called for urgent action to end violence and discrimination against lesbian, gay, bisexual, and transgender people of all ages. It’s perhaps the most commonly thought of struggle. But a lesser known, often overlooked struggle many of these people face is in regard to their mental health.

Statistically speaking, transgender people are at a drastically higher risk for things like depression, anxiety, selfharm, and suicidal ideation or attempts. A study in Boston published

in the Journal of Adolescent Health found that transsexual youth had a two-fold or three-fold increased risk of psychiatric disorders. The UCLA School of Law’s Williams Institute reported that transgender individuals have a 41 percent prevalence of suicide attempts; it’s a stark contrast to the 4.6 percent prevalence for the general population in the United States. This number is also significantly higher than the 10-20 percent of lesbian, gay, or bisexuals who report attempting suicide. In regard to depression, the American Journal of Public Health reported in 2001 that 55-62 percent of transgender persons were depressed.

This newsletter hopes to delve deeper into this topic and the people behind transgenderism to find similarities across cultures and ways in which we as a global community can learn from each other to improve the mental health of transgender individuals.

Thailand: Kathoeys

By Justin Siu

Thailand has been commonly deemed the “land of smiles”, an “oasis of tolerance”, and a “gay paradise”-names that reflect an international reputation for being extremely open and LGBT-friendly. Thailand’s Tourism Authority has even gone as far as creating campaigns such as the “Go Thai Be Free” in attempt to allure ‘pink tourism’, a niche tourism market directed at members of the LGBT 4 community . Within this community, Thailand is perhaps best known for its high prevalence of kathoeys, or maleto-female transgenders that seem to fabulously and freely strut the casual streets of Bangkok and feature in glamorous world-famous drag shows such as the Tiffany’s Show in Pattaya.

Thailand holds the greatest number of sex change operations each year and possesses an estimated 660,000 5 kathoeys .

discrimination, shame, and oppression.

The socio-political climate for this sexual minority can be, at best, described as “tolerant, but 5 unaccepting” . Oppressive local conditions have drawn many a parameters for shaping a kathoey’s right to self-determination. As per drawing a framework for the mental health of Thai katoeys, there is very limited research so we look to psycho-social risk factors that are tied to mental health and help paint an assessment of overall mental status.

Historically, traditional concepts of gender were tools implemented by the state as a mechanism to establish social order. Definitions of how women and men should act and express their sexuality were and have been sociological concepts that play a powerful role in the moral construct of good and bad, and ultimately one’s Yet, the reality for these local kathoeys sense of virtue. The historical is far from what the outside world may development of Thailand have been perceive. The everyday average world further infused with the Westernization of a kathoey is often faced with

of emerging Victorian middle-class movement in Europe where sexuality and gender was a concept to be judged for virtuousness. Given what seems to be a mix of unfavorable prejudice and discrimination above, it comes to no surprise that transgender people are at greater risk for suicide in comparison with the general population.

The research on kathoeys is limited and much of it falls under the category of HIV research and public health. Nonetheless, what does exist corresponds to the devaluing nature of Thailand’s sociocultural climate. A study on 2,000 Thai youth found that a third of students interviewed had been physically harassed, and one fourth sexually harassed. Many of them reported 6 depression and 7% attempted suicide .

This is not surprising considering another study communicating that Thai transgender youth who experience family rejection, and those who reported increased levels of social isolation and or loneliness are more likely to have

Kathoey Spotlight In Thailand, Parinya Charoenphol, nicknamed Nong Toom or the worldfamous “beautiful boxer” is perhaps both a testament and exception to Thailand’s cultural norms regarding kathoeys. She was born and raised a male by impoverished peasants living in the Thai jungle. As an adolescent male at the time, she, like her male peers, joined a Buddhist monastery but was dismissed for wearing makeup. She then apprenticed with a travelling monk before stumbling into a camp of teenage boxers wherein she joined 1 to later become one of Thailand’s most gifted and famous boxers . Unlike others, however, she gained fame by wearing makeup in the ring in addition to her skills, and performed effeminate pre-fight dance routines that drew both criticism, curiosity, and fame all at the same time.

In 2003, a film was made based on her story. Thai writer-director Ekachai Uekrongtham produced “Beautiful Boxer” wherein he accounts her life story from peasant, to famous boxer, to actress and model. Before meeting her, he admitted to his prejudice against her, accusing Toom for possibly tarnishing the image of Thai kickboxing in the eye of the international community. Yet, he “thought Toom was such a walking paradox: someone who sets out to master such a masculine sport in order to achieve his dream of becoming a woman. That’s such a crazy, built-in conflict, and being a dramatist, I realized her life could be a great story for a movie”. It was not until after meeting her that he “realized [he] had been very 2 prejudiced against her without giving her a chance.” Ironically, she was told that she would have no say in the manner she was depicted, which would be subject to the discretion of the entertainment industry.

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seriously considered suicide . On the other hand, sex reassignment according to a proper therapeutic regimen has been 2 proven to result in high levels of patient satisfaction, improvement in mood, social function, and improved quality of life .

It is important to note that the situation for the Thai LGBT population is not hopeless and that the historical drive towards a better tomorrow has shown some very tangible results. In 2002, for instance, the government stopped classifying homosexuality as a mental illness, and in 2006, military and some conservative colleges began admitting LGBT people.

In 2012, Thailand joined 85 other UN member states to vote yes on the first ever Un resolution denouncing violence and discrimination against LGBT people and, currently, a national debate ensuing same-sex partnership laws is underway.

Forward thinking on promoting the mental health of kathoeys should address LGBT and kathoey prejudice and ultimately 6 undermine the concept of gender binaries to promote gender diversification and equality .

Determinant of Mental Health Religion

Nearly 95% of Thailand’s population is Buddhist of the Theravada. According to this traditional school of thought, the life of a kathoey is a life of punishment to which LGBT persons are subject to due to committed sins (particularly adultery) in past lives. Thus, they are often stigmatized as promiscuous 6 and deserving of low social status .

Political

The Thai government does not legitimize any gender or sex transition by altering personal documentation. In Thailand, marriage is only recognized between one man and one woman. Hence, this barrs LGBT partners and kathoeys access to certain social services and benefits including joint 6 loans, housing, certain health care plans, and insurance from their partner’s employer .

Social: Media

Thai media generally portrays LGBT people in a negative way, often times using them as stock characters or comic relief on television shows.

On the other hand, there is a lack of social media reporting on incidences of harassment, discrimination and violence towards LGBT which seems to portray a false facade of Thailand’s 6 attitudes towards sexual minorities .

Medical

Homosexuality is no longer considered a mental illness by the Ministry of Health, but transsexuality is still pathologized. Transgender women, including those that have undergone sexual reassignment surgery, are not allowed to serve in the military. Until 2011, they were given a letter of dismissal due to a “permanent mental disorder”; since then, that has been changed to “Gender Identity Disorder”.

Sexual reassignment surgery is not covered by Thailand’s universal access to health policy, even for those diagnosed with Gender Identity Disorder. Any type of genital reassignment surgery is costly, 6 thus keeping many from achieving what may relieve them of their anxieties .

Social: Community

Perhaps one of the most important aspects Thai culture is family. While the Buddhist Theraveda school of thought may not promote the kathoey,,kathoeys can still in an unspoken sense, serve as “good citizens” by fulfilling familial duties. Hence, many kathoeys are still accepted by their families, but their social identity is often times very much determined by their career and or the income they bring home to support the family, contributing extra pressure for a kathoey to do well in compensation 6 for their identity .

Education

Many health education textbooks warn students against interacting with people who act like members of the opposite sex and even go as far as encouraging students to inform their teachers in order to employ adjustment measures. Most education institutions require students to wear uniforms according to their sex at birth. Those who do not comply are often times barred from taking exams or submitting coursework, essentially denying them right to education in the event of non-compliance.

This indoctrinates a gender binary that promotes discrimination, bullying, and harassment for those 6 that choose not to “dress appropriately” .

Employment

It is common for LGBT peoples to face discrimination in the workplace. It is particularly difficult for kathoeys to gain mainstream employment when their gender identities do not fit with the gender indicated on their identity cards. Many often times find themselves channeled into entertainment and 5 sex work. Thus, if possible, many choose to remain closeted to avoid such discrimination .

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Left: Hina Wong-Kalu, a mahu in Hawaii. Her story is documented in Kumu Hina, and reports on the challenges of being mahu in Hawaii, as well as the strength of Hawaiian culture.

Right: Mahuwahine practicing hula. Both transgender and hula were oppressed by Protestant missionaries in the early 1800s.

MĀHŪ: TRANSGENDER IN PARADISE

By Cherisse Sen 1

Recently named the happiest state in the nation , Hawai‘i is known for its postcard worthy scenery and welcoming “aloha spirit.” But a closer look reveals that Hawai‘i is not exactly paradise for one group of people: transgender individuals.

Caitlyn Jenner has recently drawn attention to the fact that 41% of transgender individuals in the United States have 2 attempted suicide, and it has been shown that stigma and 3,8 discrimination directly affects mental health . Sadly, Hawai‘i is not so different, despite our attempts to preach the aloha spirit. A recent study showed that 12% of transgender individuals in Hawai‘i reported a mental health issue compared to 2% of the general population. In addition, 31% use illegal drugs, 28% said they do not have a primary care physician, and 40% reported being victims of crime due to 4,9 their sexual identity and gender expression . Transgender females and gay men in Hawai‘i are sometimes mocked and called “māhū,” which is a Hawaiian word used as slang for a feminine man.

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what many historians refer to as “cultural genocide.” Māhū, once respected by Native Hawaiians, were shamed and labeled as sinners. This act of cultural and historical trauma led to a dramatic shift in cultural norms. Present day attitudes towards māhū and the rest of the LGBT community in Hawai‘i can be traced back to Western influence. When Hawai‘i first became a state, māhūwahine were forced to wear buttons that labeled “I am a boy.” While attitudes have slowly improved since then, the stigma and discrimination that māhū often face even in today’s society continues to affect their mental health. In addition, it also creates barriers to accessing health care and other psychosocial services.

We need to address the high rates of suicide, depression, substance abuse, and other mental issues not only among transgender individuals in Hawai‘i, but also the US and the rest of the world. The narrative of māhū in Hawai‘i highlights the need to understand the role of culture in gender identity However, māhū is actually a historical term dating back to the and mental health. The majority of transgender individuals in Hawai‘i (70%) are also kānaka maoli, or Native Hawaiian. pre-colonization era. In fact, māhū were once a revered and Cultural aspects can be barriers, but also strengths. accepted part of Hawaiian culture and society. The word Hawaiian culture emphasizes the role of ‘ohana, or family. refers to those born “in the middle;” individuals who embody support are both kane (male) and wahine (female) spirit. They were once And transgender individuals with strong family 4,9 at decreased risk for mental health issues .

Overall, further valued and respected in Hawaiian society as caretakers, 5,7 training on sexuality and cultural competency is needed for healers, and teachers . So how did a term that was once 6 health professionals , teachers, law enforcement, and honorary become derogatory? faith/community leaders. A recent documentary, Kumu In the pre-colonization days of ancient Hawai‘i, sexuality was Hina, tells the powerful story of Hina Wong-Kalu and her journey as a māhū in Hawai‘i. In an interview with The New a normal part of society. Aikane, or same sex relationships, York Times, Kumu Hina discusses her role to in restoring were accepted and even noted in stories about Hawaiian māhū to its proper place as a word of pride, dignity and demigods. Everyone had a role in society- kane, wahine, respect. “I strive to ensure that amongst the many aikane, and even māhū. Similar people groups exist in other contributions of our Hawaiian ancestors that are taught in Polynesian cultures such as fa’afafine (Samoa), fakafefine our classrooms, from the long voyages of our great (Tonga), and vakasalewalewa (Fiji). But Hawai‘i would navigators to the sustainable use of our lands, we include drastically change with the arrival of the first missionaries in the Hawaiian understanding of aloha – love, honor and the early 1800s. All aspects of Hawaiian culture – language, 7 respect for all, including māhū. ” This would truly be music, hula, and also sexual practices – were oppressed in paradise.

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Transgender Africa: The Forgotten People

By Valeria Rivera

Cleopatra Kambugu with her boyfriend, Nelson

Transgender people are some of the most invisible in Africa, where rigid gender stereotyping continues to suppress freedom. Many are forced to hide their identities and live on the margins of their communities or risk being vilified as immoral and unchristian by the conservative majority. Uganda, one of the 37 homophobic African countries for its worst attitude towards the LGBT community, torments the lives of transgender people, also known as 12 Kuchu . Individuals who are identified as transgender suffers social repression in the form of verbal abuse, hate crimes, and honour-related 3. violence For Uganda's transgender community, the country has become a place of torment and anxiety. As Member of Parliament, David Bahati, proposed the 2009 Anti-Homosexuality Act, many Ugandans freely expressed their disgust through acts of violence towards any person who identified as lesbian, gay, bisexual or transgender.

The bill passed on February 24, 2014, as President Yoweri Museveni signed 4 the bill into law . The Act expands the range of criminalized same-sex activities and provides harsher punishments upon conviction, 5 including life in prison . To justify the bill, Mr Bahati and his supporters said the bill is meant to prohibit the "promotion or recognition of homosexuality and to protect children and the youth who are vulnerable to 6 sexual abuse and deviation” .

However, the reality is that the LGBT populations are the ones vulnerable to sexual abuse and discrimination;

hence transgenders suffer for contradicting “the heterosexual norm.”

Alongside the abuse, transgender people are taking their own lives to escape the brutality. For example, Kuchu people are killed with impunity and the community suffers from high 7 rates of suicide attempts .It is no surprise that the constant fear and pressure to be “normal” has pushed transgender persons to suicide.

In addition, due to heightened exposure, kuchu people avoid seeking healthcare altogether because of the ignorance of medical professionals of the health concerns of kuchu people or for fear of mistreatment when their sexual orientation or gender identity is exposed at worst. A trans person explains the effects of the ignorance of the medical community about transgender people and their health concerns by saying “if you went to a

medical person who respects his medical ethics, he really has no idea how to deal with trans, he's definitely going to be blown away and unable to help you, but those instances are really small, and you don't really find 8 them” .

With this said, Uganda only allocates 4% of their budget to mental health while 96% of the budget funds all other health expenditures, excluding mental health and only 1% of health care expenditures are specifically directed towards mental health in primary 9 care . As a result of the AntiHomosexuality Act and lack of mental health access, rates of suicide attempts is increasing among transgender people in Uganda. As of now Uganda ranks at 14 in the world for suicide attempts among the LGBT 10 youth .

Yoweri Museveni signs an anti-homosexual bill into law at the state house in Entebbe, 36 km (22 miles) south west of capital Kampala February 24, 2014.

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Furthermore, though the bill was overturned by Uganda’s constitutional court on August 2014, Uganda’s transgender populace to-date suffers constant fear of social and legal punishment, with different threats of persecution, public outings, and violence. Conversely, with all the discrimination and abuse, transgender activists are speaking out and actively attempting to make a better community for transgender persons. The documentary, The Pearl of Africa, features Cleopatra Kambugu, a 27 year old transgender Ugandan woman, who through her multiple identities seeks to shine light on the underlying current 11 issues of her gender identity . Cleo utilizes media as a means to address the ongoing issues transgender people face in Uganda as well as the mental health aspect of how it is to survive as a transgender person in one the most transphobic places in the world. In conclusion, though Uganda is perturbed by transphobia, the transgender community continues to remain optimistic as activists and organizations from around the world seek to create a better and accepting world for the transgender community in Uganda.

KAMPALA, Uganda — “I was born a boy, Ceasar Kambugu, in a bourgeois suburb called Bakuli, on the outskirts of Kampala, to two loving middle-aged parents. As I grew into a transgender girl, it was a process my family couldn’t quite understand. The word transgender is absent in our local dialect, Luganda.

My parents and siblings didn’t ridicule me, but at the same time, they found my unconventional expression of gender and sexuality disconcerting. It was the elephant in the room that we chose not to discuss. I was referred to by masculine pronouns. It seemed simpler that way. My family was very protective of me — perhaps as a result of my peculiarity — but even with that protection I was still often bullied, by peers, insensitive teachers and passers-by.”

Cleopatra Kambugu, a 27 year old Ugandan Transgender Woman. She’s biologically born male, but against all odds transitioning into the woman she knows she was born to be. Following the controversial anti-gay Ugandan bill in 2014, Cleo was “outed” as homosexual in popular tabloid Red Pepper. Within a week, "I officially lost my job and several of my family members abandoned me fearing for their safety" said Cleo. She eventually was forced to flee to Kenya for her safety. To discuss the ups and lows of her life in Uganda, Cleopatra documents her life in her web series, The Pearl of Africa, where she talks about love, hate and being transgender in one of the world’s most transphobic places.

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Anti-gay supporters celebrate after Uganda's President Yoweri Museveni signed a law imposing harsh penalties

References (Additional references included at end) 1. Kitara, T. (2014, November 19). Comment: Uganda’s LGBT community is in limbo pending a new anti-gay bill. Retrieved April 19, 2016, from http://www.pinknews.co.uk/2014/11/19/comment-ugandas-lgbtcommunity-is-in-limbo-pending-a-new-anti-gay-bill/.

2. Kuchu: A self-identifying term used by the lesbian, gay, bisexual, and transgender community in Uganda. (Shadows report) 3. Espien, E. (2007). GENDER and SEXUALITY-Supporting Resources Collection. Bridge Development-Gender, 36-36. Retrieved April 16, 2016, from http://www.bridge.ids.ac.uk/sites/bridge.ids.ac.uk/files/reports/CEPSexuality-SRC.pdf 4. K. (Ed.). (2014). Uganda: Anti-Homosexuality Act Kaleidoscope Briefing. Kaleidoscope Trust, 2-3. Retrieved April 16, 2016, from http://kaleidoscopetrust.com/usr/resources/26/uganda-briefingkaleidoscope-260214.pdf 5. Expanded Criminalisation of Homosexuality in Uganda: A flawed narrative, Sexual Minorities Uganda, 20 January 2014. http://www. sexualminoritiesuganda.com/images/expanded%20criminalisation%20o f%20homosexuality%20in%20uganda-%20january%202014.pdf

El Salvador: Las Travestis

By Angie Mar LGBT rights march at San Salvador’s iconic Constitution Monument, for International Day Against Homophobia and Transphobia 2014.

Situated comfortably in Central America, El Salvador is the traveler’s paradise filled with forests, surfing meccas, archaeological sites featuring Mayan ruins, and delicious yet affordable foods. For many travelers, it is the perfect place to avoid the crowds while enjoying the breathtaking views. For others, especially those of the LGBTI community, El Salvador should be at the bottom of their vacation lists. According to the Gay Travel Index, El Salvador is ranked as the 108th most liberal and gay 1 friendly of 194 countries . While El Salvador has legislation meant to protect those of the LGBTI community, many still face widespread discrimination.

Even though El Salvador is Central America’s smallest country, the recent wave of attacks on the transgender community has called the attention of several international human rights institutions. In response to the violence as well as pressure from the international institutions, former president Mauricio Funes established a Sexual Diversity Directorate within his administration.

Executive Degree 56, a public policy tool, forbids discrimination by public officials for reasons of sexual orientation or gender identity. Even so, violence and discrimination continues. But because Funes’s advances for the LGBTI community were based on his executive

decree instead of legislative action or a popular vote, the current president Sanchez Ceren can overturn Executive 3 Degree 56 .

The current discrimination against the LGBTI community in El Salvador in education, employment opportunities, access to healthcare, and identity documents has been plaguing community members. The fear of being abused, harassed, or mocked during the process of filing a complaint were among the reasons cited by activists as preventing many victims from coming forward. Activists also stated that family members of victims are often reluctant to come forward to file complaints or corroborate claims of victims because they experience similar forms of harassment due to the stigma 4 associated with being a relative of an LGBT individual .

Some community members even described fear of possible retaliation, particularly in instances in which the crime involved gang violence, as an additional barrier to reporting 5 crimes and rights violations . Due to the discrimination faced in the workplace, close to 47% of transgender women opt to sell sex for their main source of income. Selling sex has been significantly associated with low levels of education, homelessness, drug use and a perceived lack of social 6 support .

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Case study: “Bloody June” • In June 2009, El Salvador experienced an unprecedented wave of targeted violence against the LGBT community. On June 9, Tania and Katerina, two transgender women and sex workers were kidnapped in San Salvador. The next morning, Katerina’s body was found face down in a muddy ditch; she had been strangled and beaten. Tania was still missing. When friends called Tania’s cell phone an unknown voice threatened: “She is going to die, it is what she deserves.” Seven days later her partially dismembered body was found. She was seventeen years old.

• That same summer, the body of a 25 year old gay man was found in a plastic bag, his hands had been dismembered and his body showed other signs of torture.

Not surprisingly, public officials, including police, engaged in violence and discrimination against sexual minorities.

Members of the LGBT community stated that the agencies in charge of processing identification documents ridiculed them when they applied for identification cards or reported cases of violence against LGBT persons. The government responded to these abuses primarily through reports that publicized specific cases of violence and discrimination against sexual minorities. No other action was taken.

Every year, many members of this community are beaten, raped, and verbally harassed by general citizens and government officials. While the government has taken a step forward by allowing transgenders to vote for the first time in Salvadoran history in 2014, more action is needed to ensure equality for all Salvadorans. How can others visit this beautiful country when even the current citizens of El Salvador are being targeted?

• On June 30, an eighteen year old gay man was found shot, evidence indicated that he had been held captive and tortured for several hours before being killed.

• A transgender woman, Betzayda, was found in July at the bottom of a ravine; authorities say the cause of death was a gunshot wound.

• This series of murders has come to be known as ‘Bloody June’ and followed a heated political debate in the Legislative Assembly regarding a constitutional ban of same-sex marriage. No one has been convicted of any of the murders from Bloody June.

Alex Pena, director of the Association of Transgender Men in El Salvador, was allegedly attacked by four police officers

References 1. Spartacus: International Gay Guide . “Gay Travel Index .” . http://www.spartacusworld.com/gaytravelindex.pdf (accessed April 23, 2016).

2. "El Salvador." Embassy of the United States. N.p., 2014. Web. 23 Apr. 2016.

3. Mackey, Danielle, and Gloria Moran. "Transgender People Voted for the First Time in El Salvador's History." GlobalPost.

GlobalPost, 25 Mar. 2014. Web. 23 Apr. 2016.

4. University of California, Berkeley, School of Law, International Human Rights Law Clinic. "Sexual Diversity in El Salvador."

The Relativity of Devianc(2012): 227-60. Web. 23 Apr. 2016.

5. Interview with Alba América Girola Zelaya, Directora Ejecutiva, CEMUJER, in San Salvador, El Salv. (Feb. 21, 2011) [hereinafter Interview with CEMUJER].

6."Transgender People." The Gap Report 2014 (2014): n. pag. UNAIDS. 2014. Web. 23 Apr. 2016.

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Sweden: A Global Example

By Sam Segal Sweden is unlike many other countries in the EU nation in regards to the LGBT community. They fully embrace LGBT people and were the first in the world to provide them with legal rights. Sweden not only leads the forefront in the EU nation but California, which is considered as one of the most liberal state in the U.S. in regards to LGBT rights decriminalized homosexuality only in 1976, 32 years after Sweden did in 1944. In addition, Sweden was the first country in the world in 1972 to allow transgender persons to change their legal gender. And the National Board of Health and Welfare declassified homosexuality as a mental disorder in 1979.

Sweden has taken important steps to ensure that LGBT people enjoy the same rights and opportunities as everyone else in their society. The RFSL, which is the Swedish Federation for LGBT people, is a non-profit organization founded in 1950. In addition, there are a number of LGBT organizations ranging from those affiliated with a political party to youth organizations to organizations for a particular occupation such as the Swedish gay police association. Not only do these organizations fight for the rights of people who are prosecuted in their home country but they also provide asylum to those who are prosecuted in their home countries as homosexual acts are still outlawed in approximately 90 countries and territories around the world. A court in Moscow, Russia ruled that gay pride celebrations were prohibited in the city till the year 2112. Instead of waiting, Stockholm Pride unveiled a Twitter campaign, #GoWest that welcomes Russians to travel to Sweden for their Pride celebrations.

Sweden has also gone on to establish a gender-neutral pronoun “hen” in the country’s official SAOL dictionary.

The gender-neutral term can be used if the gender is unknown or not relevant or for inter-gender people. In Egalia, a preschool in Stockholm, all children are referred to as “hen”. In addition, Stockholm, has dedicated eight million kronor to fund LGBT lessons in primary and secondary schools to promote and broaden the acceptance of LGBT among children. Sweden also started the world’s first LGBT national team in an effort to stop homophobia within sports as Stefan Lövgren, CEO of the Swedish handball team and former captain of the national team, said: “Obviously, it is very important to highlight the question of LGBT sports, and through these national teams we can be clear about our position and show our support, thus taking on a new role in society, which makes me happy and proud”.

Sweden is one of the most LGBT-friendly countries in the world because people continue to fight for further improvements both nationally and globally. However, changes still need to be made in Sweden as health care professionals make illogical connections between a disease and the patient’s sex identity or expression or have attitudes that create discriminatory decisions. There is no requirement for health care professionals to have knowledge or training regarding LGBT related issues. In addition, as reported by the RFSL there were 172 people in 2015 who were victims of homophobic, biphobic or transphobic hate crimes. Nonetheless, more countries need to be as progressive as Sweden in addressing the LGBT community.

Marchers of the Gay Pride Parade in Sweden.

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ADDITIONAL REFERENCES Introduction: 1.

Clements-Nolle, Kristen, Rani Marx, Robert Guzman, and Mitchell Katz. "HIV Prevalence, Risk Behaviors, Health Care Use, and Mental Health Status of Transgender Persons: Implications for Public Health Intervention." American Journal of Public Health 91.6 (2001): 915-21. NCBI. Web. 23 Apr. 2016. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446468/pdf/11392934.pdf 2.

Haas, Ann P., Philip L. Rodgers, and Jody L. Herman. "Suicide Attempts among Transgender and Gender Non-Conforming Adults: FINDINGS OF THE NATIONAL TRANSGENDER DISCRIMINATION SURVEY." The William Institute (n.d.): n. pag. The Williams Institute: UCLA Law School. Web. 24 Apr. 2016. http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf 3.

"MercatorNet: What Do the Statistics Say about Transgender Mental Health?" MercatorNet. N.p., 23 Oct. 2015. Web. 24 Apr. 2016. http://www.mercatornet.com/conjugality/view/what-do-the-statistics-say-about-transgender-mental-health/17054 4.

Reisner, Sari L., Ralph Vetters, M. Leclerc, Shayne Zaslow, Sarah Wolfrum, Daniel Shumer, and Matthew J. Mimiaga. "Mental Health of Transgender Youth in Care at an Adolescent Urban Community Health Center: A Matched Retrospective Cohort Study." Journal of Adolescent Health 56.3 (2015): 274-79. Web. 23 Apr. 2016. http://www.jahonline.org/pb/assets/raw/Health%20Advance/journals/jah/feature.pdf 5.

"Transgender People." World Health Organization. N.p., n.d. Web. 24 Apr. 2016. http://www.who.int/hiv/topics/transgender/en/ Thailand: 1. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons. Journal of Homosexuality, 51, 53-69. doi: 10.1300/J082v51n03_04 2. Giltay, Erik, et al. “Exploration of functional health, mental well-being and cross-sex hormone use in a sample of Thai male-to-female transgendered persons (kathoeys)”. Asian Journal of Andrology. 2013 march: 15(2): 280-285.

3. Goldblum, P., Testa, R. J., Hendricks, M. L., Bradford, J., & Bongar, B. (2012). The relationship between gender-based victimization and suicide attempts in transgender people. Professional Psychology: Research and Practice, 43, 468-475, doi: 10.1037/a0029605 4. Gray, Hunter. “Negotiating Invisibility: Addressing LGBT Prejudice in China, Hong Kong, and Thailand” (2014). Master’s Capstone Projects. Paper 30. http://scholarworks.umass.edu/cie_capstones/30 5. Ocha, Witchayanee. “Rethinking Gender: Negotiating Future Queer Rights in Thailand”. Gender, Technology, and Development 2013: 17(1) p. 79-104.

6. UNDP, USAID (2014). Being LGBT in Asia: Thailand Country Report. Bangkok.

Kathoey Spotlight: 1. Hugh Hart. “True Tale of Change for Thai Kickboxer”. SFGate. 23 January 2005. Web. April 2016.

2. Smith, Neil. “Thai film’s transsexual glove story”. BBC News. 22 August 2005. Web. April 2016.

Hawaii: 1. New Research Ranks Well-Being in the U.S. by State. (2016, January 27). Retrieved from http://www.well-beingindex.com/2015-state-rankings 2. Grant, J. M., Mottett, L. S., & Tanis, J. (2011). Injustice At Every Turn: A Report of the National Transgender Discrimination Survey (Rep.). WA: The National Gay and Lesbian Task Force and the National Center for Transgender Equality.

3. LGBTQ Mental Health. (n.d.). Retrieved April 21, 2016, from https://www.nami.org/Find-Support/LGBTQ 4. Stotzer, R. L., & Hollis, A. (2013). LGBTQI Hawai‘i: A Needs Assessment of the Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Communities in the State of Hawai‘i, Preliminary Findings. Myron B. Thompson School of Social Work, University of Hawai‘i at Mānoa: Honolulu, HI. 5. Marsh, A. (2011). Le’ale’a O Na Poe Kahiko - Joy of the People of Old Hawai’i. Electronic Journal of Human Sexuality, 14. Retrieved April 15, 2016, from http://www.ejhs.org/volume14/Joy.htm 6. Wong J. (2014). Looking forward and enriching John A. Burns School of Medicine's curriculum: lesbian, gay, bisexual, and transgender healthcare in medical education. Hawaii J Med & Public Health, 73(10), 329–331.

7. Wong-Kalu, H. K. (n.d.). Kumu Hina. Retrieved April 15, 2016, from http://www.nytimes.com/interactive/projects/storywall/transgender-today/stories/kumuhina 8. Hunt, J. (2012). Why the Gay and Transgender Population Experiences Higher Rates of Substance Use (Publication). Center for American Progress. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2012/03/pdf/lgbt_substance_abuse.pdf.

9. Odo, C., & A. H. (2001). Eo na Mahu o Hawai'i: The extraordinary health needs of Hawai'i's Mahu. Pacific Health Dialogue, 8(2), 327-334.

10. Stotzer, RL, Ka’opua LS, & Diaz, TP (2014). Is healthcare caring in Hawaii? Preliminary results from a health assessment of lesbian, gay, bisexual, transgender, questioning, and intersex people in four counties. Hawaii J Med & Public Health, 73(6):175-80.

Uganda: 6. Mmali, J. (2009, December 22). Uganda Fear Over Gay Death-Penalty Plans. BBC News. Retrieved April 18, 2016, from http://news.bbc.co.uk/go/pr/fr//1/hi/world/africa/8412962.stm 7. C. (2010). Violation of the Human Rights of Lesbian, Bisexual, Transgender (LBT), and Kuchu People in Uganda. Outright Action International, 27. Retrieved April 19, 2016, from https://www.outrightinternational.org/documentation/shadow-reports.

8. C. (2010). Violation of the Human Rights of Lesbian, Bisexual, Transgender (LBT), and Kuchu People in Uganda. Outright Action International, 27. Retrieved April 19, 2016, from https://www.outrightinternational.org/documentation/shadow-reports.

9. Kigozi, F., Ssebunnya, J., Kizza, D., Cooper, S., Ndyanabangi, S., & the Mental Health and Poverty Project. (2010). An overview of Uganda’s mental health care system: results from an assessment using the world health organization’s assessment instrument for mental health systems (WHO-AIMS). International Journal of Mental Health Systems, 4, 1. http://doi.org/10.1186/1752-4458-4-1 10. https://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate 11. Wallstrom, J. V. (Director). (2016). The Pearl of AFrica [Motion picture on Documentary]. Africa.

Sweden: 1.

Lagerberg, Rikard. “ Working For a Gay-Friendly Sweden”. N.p., 8 Jan. 2016. Web. 24 Apr. 2016. https://sweden.se/society/working-for-agay-and-equal-sweden/ 2.

Noack, Rick. “Sweden is about to add a gender-neutral pronoun to its official dictionary”. The Washington Post. N.p., 1 Apr. 2015. Web. 25 Apr. 2016. https://www.washingtonpost.com/news/worldviews/wp/2015/04/01/sweden-is-about-to-add-a-gender-neutral-pronoun-to-itsofficial-dictionary/ 3.

Rudolph, Christopher. “ Stockholm Pride’s Go West Campaign Invites Russia Gay Community to Celebration Via Twitter.” Huffington Post.

N.p., 15 May 2013. Web. 25 Apr. 2016. http://www.huffingtonpost.com/2013/05/15/stockholm-pride-go-west-russia_n_3279312.html 4.

Deacon, Liam. "Schools To Have Dedicated ‘LGBT Awareness’ Classes in Sweden." BreitBart. N.p., 28 Aug. 2015. Web. 25 Apr. 2016. http://www.breitbart.com/london/2015/08/28/schools-to-have-dedicated-lgbt-awareness-classes-in-sweden/ 5.

Carlsson, Andreas. “Sweden Starts The World’s First LGBT National Team.” Stockholm Snipers. N.p., Apr. 2014. Web. 25 Apr. 2016. http://stockholmsnipers.se/sweden-starts-worlds-first-lgbt-national-team

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